Alzheimer's disease is the most common form of dementia affecting more than 20 million people worldwide.
Diagnosis of the disease, in particular at an early point, is troublesome and difficult and there exists a need for accurate diagnosis of tauopathies such as Alzheimer's disease. Antibody detection of abnormal Tau in cerebrospinal fluid has shown some promise (Blennow et al. “Cerebrospinal Fluid And Plasma Biomarkers In Alzheimer Disease,” Nat. Rev. Neurol. 6, 131-144 (2010) and Weiner et al. “The Alzheimer's Disease Neuroimaging Initiative: A Review Of Papers Published Since Its Inception,” Alzheimers. Dement. 9, e111-e194 (2013)).
Over the years, antibody detection of phospho-Tau protein in cerebrospinal fluid has shown some utility for diagnosis of Alzheimer's disease (Blennow et al. “Cerebrospinal Fluid And Plasma Biomarkers In Alzheimer Disease,” Nat. Rev. Neurol. 6, 131-144 (2010); Lewis, J. et al. “Neurofibrillary Tangles, Amyotrophy And Progressive Motor Disturbance In Mice Expressing Mutant (P301L) Tau Protein,” Nat. Genet. 25, 402-405; Weiner, M. W. et al. (2013) “The Alzheimer's Disease Neuroimaging Initiative: A Review Of Papers Published Since Its Inception,” Alzheimers. Dement. 9: e111-e194), suggesting that further development in this arena is warranted (see, Congdon, E. E. (2014) “Harnessing The Immune System For Treatment And Detection Of Tau Pathology,” J. Alzheimers. Dis. 40:S113-S121). However, CSF Tau levels in other tauopathies are usually not altered compared to controls (Theunis, C. et al. “Efficacy And Safety Of A Liposome-Based Vaccine Against Protein Tau, Assessed In Tau. P301L Mice That Model Tauopathy,” PLoS. One. 8, e72301 (2013); Hales, C. M. et al. (2013) “From Frontotemporal Lobar Degeneration Pathology To Frontotemporal Lobar Degeneration Biomarkers,” Int. Rev. Psychiatry 25:210-220), and imaging dyes may not detect pathological Tau in all tauopathies (Fodero-Tavoletti, M. T. et al. (2014) “Assessing THK523 Selectivity For Tau Deposits In Alzheimer's Disease And Non-Alzheimer's Disease Tauopathies,” Alzheimers. Res. Ther. 6:11). Imaging these Tau lesions in concert with amyloid-β (Aβ) is more likely to lead to accurate diagnosis as the regional pattern of Tau aggregates differs between the different tauopathies. Furthermore, all of them except Alzheimer's disease are in part defined by lack of Aβ deposition. In vivo imaging of Aβ plaques using compounds that bind well to β-sheets is already in clinical use (Mason, N. S. et al. (2013) “Positron Emission Tomography Radioligands For In Vivo Imaging Of ABeta Plaques,” J. Labelled Comp. Radiopharm. 56:89-95). Several such dye-based Tau-binding ligands have been identified recently in preclinical studies and some of those are being evaluated (Fodero-Tavoletti, M. T. et al. (2014) “Assessing THK523 Selectivity For Tau Deposits In Alzheimer's Disease And Non-Alzheimer's Disease Tauopathies,” Alzheimers. Res. Ther. 6:11; Fodero-Tavoletti, M. T. et al. (2011) “18F-THK523: A Novel In Vivo Tau Imaging Ligand For Alzheimer's Disease,” Brain 134:1089-1100; Zhang, W. et al. (2012) “A Highly Selective And Specific PET Tracer For Imaging Of Tau Pathologies,” J. Alzheimers. Dis. 31:601-612; Chien, D. T. et al. (2013) “Early Clinical PET Imaging Results With The Novel PHF-Tau Radioligand [F-18]-T807,” J. Alzheimers. Dis. 34:457-468; Maruyama, M. H. et al. (2013) “Imaging Of Tau Pathology In A Tauopathy Mouse Model And In Alzheimer Patients Compared To Normal Controls,” Neuron 79:1094-1108; Okamura, N. et al. (2005) “Quinoline And Benzimidazole Derivatives: Candidate Probes For In Vivo Imaging Of Tau Pathology In Alzheimer's Disease,” J. Neurosci. 25:10857-10862; Harada, R., et al. (2013) “Comparison Of The Binding Characteristics Of [18F]THK-523 And Other Amyloid Imaging Tracers To Alzheimer's Disease Pathology,” Eur. J. Nucl. Med. Mol. Imaging 40:125-132; Ono, M. et al. (2011) “Rhodanine And Thiohydantoin Derivatives For Detecting Tau Pathology In Alzheimer's Brains,” ACS Chem. Neurosci. 2:269-275; Xia, C. F. et al. (2013) “[(18)F]T807, A Novel Tau Positron Emission Tomography Imaging Agent For Alzheimer's Disease,” Alzheimers. Dement. 9:666-676; Chien, D. T. (2014) “Early Clinical PET Imaging Results With The Novel PHF-Tau Radioligand [F18]-T808,” J. Alzheimers. Dis. 38:171-184; Villemagne, V. L. et al. (2014) “In Vivo Evaluation Of A Novel Tau Imaging Tracer For Alzheimer's Disease,” Eur. J. Nucl. Med. Mol. Imaging 41:816-826; Okamura, N. et al. (2014) “Non-Invasive Assessment Of Alzheimer's Disease Neurofibrillary Pathology Using 18F-THK5105 PET,” Brain 137:1762-1771). The hope and promise for Tau based ligands is that they will be better than Aβ ligands to monitor the status and progression of neurodegeneration. Antibody-based probes are likely to provide greater specificity for detecting Tau lesions. In particular, smaller antibody fragments that bind to Tau are attractive as ligands for in vivo imaging to detect Tau lesions in patients with Alzheimer's disease or other tauopathies.
Within the cancer field, therapeutic antibodies have routinely been co-developed as imaging agents, and several such antibodies and Fab molecules are FDA approved for tumor imaging (Kaur, S. et al. “Recent Trends In Antibody-Based Oncologic Imaging,” Cancer Lett. 315, 97-111 (2012)).
The present inventors have found antibody-derived imaging ligands that provide excellent specificity for detecting Tau lesions, and in particular smaller single-chain variable antibody fragments (scFv molecules) which are attractive for in vivo imaging of Tau aggregates. It is envisaged that these antibody-derived imaging ligands can be useful in monitoring disease progression of Tau pathology, the efficacy of Tau-targeting therapies, and to identify Aβ negative tauopathies.